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RE <br />SAN JOAWN COUNTY bur 0 7 <br />ENVIRoNmENTAL HBkLTwDEPARTMENT <br />600 East Main Street, Stockton, CA 95202 3029 ENVIRU14MENT HEALTIA <br />Telephone: (209) 468-3420 Fox. (209) 468-3433 Web: WWW.siq2VW*kSERV10ES <br />RETURN TO COMPLIANCE CERTIFICATION - <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be <br />corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br />Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using, this certification and returned to EHD within 30 days <br />unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate. <br />For this certification to be completethe operator of the site must include: <br />• A statement documenting what corrective actions were taken or will be taken for each violatio <br />• Copies of sample results/manifests/training records/other appropriate paperwork, and/or phot <br />verifying corrections <br />no <br />Inspection Date: ZO 9' inspected By:jeAv TZ -6'K* <br />7— <br />Facility Address:IV71, 4 1,1,'A,1_ EPA ID#: e:54Z, 00 <br />®ce:?_ <br />I certify under penalty of law that: <br />1. 1 have- corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. - <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos 9 -paperwork statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. 1 am aware that there are significant penalties for submitting false information, including the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Name: r_.'nUA,_ KA���j Title: MA� 6 tz- <br />Date: (0 .57- e 9 <br />